Postpartum Depression: What Is it and Why Does it Appear?

19 April, 2021
This article has been written and endorsed by la psicóloga Paula Villasante
Sometimes the symptoms of postpartum depression can be confused with symptoms of major depression, or with specific postpartum depressive symptoms.

Postpartum depression (PPD) is a mental health problem that turns out to be as common as it is serious. It’s associated with maternal suffering and a series of negative consequences for babies.

Treatment for postpartum depression depends on the severity of the symptoms. Mild cases can be addressed with psychosocial strategies, while for moderate depression, psychological therapy is recommended.

In severe cases, drug therapy, usually a selective serotonin reuptake inhibitor (SSRI), is recommended as a first-line treatment. However, what is postpartum depression exactly? And, above all, why does it appear?

Postpartum depression: what is it?

It’s a disabling but treatable mental disorder. It also represents one of the most common complications of motherhood. So much so, that it’s included in the fifth edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

Here it’s defined as a major depressive episode “with peripartum onset if the onset of mood symptoms occurs during pregnancy or within 4 weeks after delivery.”

However, depression that begins 4 weeks after delivery or doesn’t meet the criteria for a major depressive episode can still cause many problems and require treatment.

Postpartum depression requires professional care.
Psychological and psychiatric consultations are necessary to diagnose this disease.

Symptoms of postpartum depression

These often include sleep disorders (such as insomnia), anxiety, irritability, and a feeling of being overwhelmed, as well as an obsessive concern about the baby’s health and feeding.

Suicidal ideas and various concerns about harming the baby can also occur. Otherwise, the symptoms of postpartum depression often coincide with the symptoms of a major depressive episode. These can be the following:

  • Significant weight loss
  • Psychomotor agitation or retardation
  • Fatigue
  • Feelings of worthlessness or excessive or inappropriate guilt
  • A decreased ability to think or concentrate, as well as indecision

The symptoms cause significant distress or impairment in social, occupational, or other important functional areas. These aren’t due to direct physiological effects of a substance or other medical condition, and aren’t explained by schizoaffective disorder or other psychotic disorders.

Diagnosis of postpartum depression

To this day, there’s still some controversy about the best method to detect postpartum depression.

For their part, both the American College of Obstetricians and Gynecologists and the American Academy of Pediatrics recommend the administration of the 10-item Edinburgh Postnatal Depression Scale (EPDS) as a method to identify possible postpartum depression.

The evaluation of women with possible postpartum depression requires a careful medical history to determine their diagnosis, identify coexisting psychiatric disorders, and manage the medical and psychosocial problems that contribute to the diagnosis of this disease.

Most patients peak in symptoms 2 to 5 days after delivery. These symptoms usually start to go away in 2 weeks.

Thus, it can be difficult to distinguish between these mild symptoms and postpartum depression as such, but assessing mood and the severity of symptoms at different times can facilitate this distinction.

Postpartum depression: why does it appear?

Postpartum depression doesn’t appear out of nowhere. There are certain risk factors that make a woman more prone to the disease, such as the following:

  • Personal or family history of depression
  • Anxiety during pregnancy
  • High neuroticism
  • Low self-esteem
  • A bad marital relationship
  • Little social support
  • Low socioeconomic status
  • Being single
  • Unwanted pregnancy
  • A difficult childish temperament

In summary, these risk factors reflect the social position of women and their access to “buffer” resources with respect to motherhood. These partly reflect environmental stressors and social support and, on the other hand, they also reflect recent and ongoing symptoms of depression and anxiety, as well as personality disorders.

Consequences of postpartum depression

Like major depression that can occur at other times in a woman’s life, postpartum depression creates personal suffering that reduces a woman’s ability to function effectively in many areas of her life.

The key thing about this type of depression, and what sets it apart from major depression, is that women with postpartum depression have a greater responsibility in caring for the child in question, and ongoing depression can interfere with the parenting of the children.

Maternal disability

Postpartum depression can persist for a long period of time and is likely to be associated with recurrent depressive episodes.

It’s also associated with an increase in negative emotion levels and a decrease in positive emotions. These characteristics suggest that the exposure of infants to negative maternal affection will be significant and long-term.

Raising children

Postpartum depression can affect many aspects of maternal care. The negative impact of depressive symptoms is evident in one of the first interactions with the baby: breastfeeding. This can be a problem, given the importance of breastfeeding in the baby’s development.

On the other hand, women with depressive symptoms are less likely to attend routine immunization visits, use safety devices at home, or place babies in a recommended sleeping position.

Additionally, postpartum depression itself is also associated with problematic practices in putting babies to sleep, as well as using car seats incorrectly, for example. Mothers with postpartum depression are more likely to neglect and abuse their children.

Consequences for the child

Children can also suffer from the effects of postpartum depression.
Not only mothers are affected by this pathology, as children can suffer problems in their emotional development

Maternal depression is associated with behavioral, cognitive, and health-related consequences for the developing child.

Behavior and cognitive development

The first six months postpartum are associated with behavioral problems from infancy through to adolescence.

Children whose mothers suffer, or have suffered, from postpartum depression appear to be more vulnerable to developmental delay. Furthermore, there appears to be a clear relationship between the child’s exposure to maternal depression and the more problematic outcomes in their cognitive development.

It’s also suggested that the chronicity of depressive symptoms in postpartum depression could contribute to the vulnerability of children to developmental delay.

Physical health

As we mentioned, mothers with postpartum depression are less likely to take good care of the child. Due to this irregular caring behavior of a depressed mother, her baby’s health can be affected.

Specifically, it seems that they could have a poorer cardiovascular function, as well as being more prone to gastrointestinal and lower respiratory tract infections.

Treatment of postpartum depression

The treatment of postpartum depression can be divided between psychological treatment and drug treatment.

Psychological treatment

There are four main approaches to treating postpartum depression: general counseling (also known as listening visits), interpersonal psychotherapy, cognitive-behavioral therapy, and psychodynamic therapy.

Pharmacotherapy

Antidepressant medication is the most widely-used treatment for postpartum depression. Some medications used in these cases are sertraline, paroxetine, venlafaxine, fluoxetine, nezafone, and nortriptyline.

A real problem that must be detected in time

In case of symptoms related to postpartum depression, it’s advisable to seek professional help as soon as possible. For some people, it can be difficult due to the social stigma associated with counseling, despite the obvious benefits that counseling can provide.

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  • Beck, C. T. (2002). Postpartum depression: A metasynthesis. Qualitative health research, 12(4), 453-472.
  • Tang, L., Zhang, X., & Zhu, R. (2020). What Causes Postpartum Depression and How to Cope with It: A Phenomenological Study of Mothers in China. Health Communication, 1-10.